So, what does cause (lower) leg cramps on keto?

(Bob M) #1

I’ve recently been getting lower leg cramps (after 5.5 years on low carb/keto). These are basically calve cramps. Got them several times at night during my last 4.5 day fast. Got them last night in the pool. Last night, I went in and drank some pickle juice. Did not have cramps after that (which could just be happenstance).

However, pickle juice does not affect sodium blood concentration:

Pickle juice does seem to inhibit cramping, but they don’t know why:

I try to eat and drink salt. Is it (not enough) salt, magnesium, potassium, …?

I have not been taking magnesium for a while. I bought magnesium orotate, started taking it, but this caused me to have heart palpitations. (This took a while to figure out the cause, but I believe I’ve traced it to magnesium orotate.) Since I have that supplement but can’t take it, I’m going to buy another magnesium supplement tonight.

But I see many explanations for cramping while on low carb, but no real answers. And none supported by studies. (Which doesn’t mean much, since how many studies are there on keto people for this?)

If you had cramps, what did you do?

I should also note that I’m now jogging on the weekends again, only one jog for about 40-50 minutes, in flat (no support) shoes. Not sure whether this affects anything, as I did not work out at all during my 4.5 day fast.

(It's all about the bacon, baby!) #2

Low magnesium and/or potassium are the usual culprits. But be careful with potassium, hyperkalemia is just as dangerous as hypokalemia.


Funny you should mention this. I’ve had no cramps whatsoever during my Keto journey until I did two 12.5 hours shifts in my new job in flat shoes. As a precaution I’ve ditched them in favour of more supported footwear.

Hope you get it sorted x

(Michael - Don't expect miracles and you won't be disappointed.) #4

‘Night cramps’ are pretty common and get more common as we age. So they seem to be more age-related and are definitely not a problem specific to keto. I suffered them for years prior to eating keto. When they started being a real problem for me several years ago I was shocked to discover their specific cause and cure are unknown. Although, as @PaulL points out the most likely suspects are potassium and/or magnesium deficiency. My layman’s guess is that as we age we tend to ingest less electrolytes in our diet, particularly potassium, and the balance required to maintain healthy muscle function tends to go off kilter more and more.

Sodium in interstitial fluid and potassium within cells have to be in balance for the muscle cells to contract properly. When they’re out of balance, we get the cramps. By the way, not limited only to the feet, ankles and calves either! I often get cramps in my sides and back when pulling my socks on in the morning and even sometimes during the day when I simply stretch my arms to the sides!

Since keto restores normal kidney function, we tend to lose more electrolytes than non-keto folks (along with a lot of other water soluble waste, so that’s a good thing). But it does mean that we have to ingest more to replenish. My opinion is that sodium is prevalent in food and probably requires less supplementation to maintain a healthy level. Whereas potassium is not so and probably requires more supplementation. The daily requirement for magnesium is fairly low, so I suspect it requires least supplementation of the three.

In another topic I linked to a study about the prevalence of hyperkalemia in the US. At least half of the people with hyperkalemia suffered from chronic kidney disease and/or heart failure. Unless you are one of those people, I think you would purposely have to work at supplementing potassium to get there. Keep in mind that sodium seems to be the overall controlling electrolyte, so unneeded excess of any of the three will get excreted quickly as long as you get sufficient sodium.

Finally, calcium is also part of the equation, but I don’t know if its exact role is any better known than that of the other electrolytes. Most people as they age tend to consume less calcium, even losing much of what they already have. If you don’t eat sufficient calcium the metabolism will take it from your bones which is why so many elderly folks suffer not only night cramps but osteoporosis.

In my case, experimenting with electrolyte supplementation I have managed to reduce the severity of my night cramps to the point where if one starts, I can usually stop it by simply relaxing the affected area. Previously, I was not able to do so and had to endure the pain and contractions until they stopped of their own accord. Also, I can actually go for several nights in a row without getting any! This never occurred before I started supplementation. It was a nightly thing, something that often deterred me from going to bed just to avoid what I knew was coming.

Cramp so bad that I had a bad fall out of bed!

I usually have cramps in the same spot. I work on my feet 10 hours + every day, so that effects it, but things get worse if I dont take my magnesium. I usually take magnesium citrate, i think i heard it apsorbs better and faster.


Yeah, magnesium and potassium would be my first though, my husband used to get really bad leg cramps until I convinced him to start using magnesium oil regularly… which seemed to mostly sort it except the occasional cramping issue. If he takes potassium then… no more issues.

I started getting some mild cramping a while back, the magnesium oil seemed to help, but what got rid of it completely was eating liver once a week… no more calves cramping… at all (wether I take magnesium or not) don’t know why but haven’t had any issue since I started that (pate! Yumm!) can only guess theres something in the liver my body needed.

(Peg Prince) #7

thanks Michael, I believe I am getting enough Calcium (I am an almond junkie - and I dry roast them and salt them). But I may need to add some sold in capsules and see if that makes any difference!

Cramp so bad that I had a bad fall out of bed!
(Heidi ) #8

The only thing that stopped leg cramps for me was taking in more salt. I tried a range of magnesium, potassium, calcium and nothing helped. I almost had to stop keto as I was desperate to stop them. Before bed I hold water in my mouth, tip my head back and put up to .5 tsp of salt down the hatch! (I describe the method because it’s the quickest way of getting it down without tasting it too much. Can’t dilute and drink -gross)
I first discovered how effective this was when I was up one night on the verge of getting cramps (I feel slightly twitches first) took in the salt and within 1min! Felt the muscles relax. I have no had even 1 cramp since I discovered that this was the missing thing for me. Now I have a good sense for when I need it, but generally I take a tsp before bed and again n the morning then salt my food throughout the day. I always thought I was getting enough with my food…not even close… Experiment. You may need even more.
Another great read is “The salt fix” Dr. DiNicolantonio

I really hope this helps. I was really a mess before figuring this out.

Good luck

(Edith) #9

For me, cramps have definitely been caused by not enough salt. If I don’t take in 1.5 teaspoons of salt a day in addition to the salt in my food, I get calf and sometimes hamstring cramps that night. This summer has been particularly hot in my area and I’ve had to up my salt to almost 2 teaspoons a day.

I keep a mix of four parts salt and one part No Salt in a jar and just toss that down with a glass of water three to four times a day. That keeps the cramps at bay. I also take 800 mg of magnesium glycinate per day, but that is to keep the heart palpitations from returning.

The brine in the pickle juice has salt. It must have something to do with that even if the blood sodium levels didn’t change during the experiment referenced above. Pickle juice also has vinegar, but I don’t know why that would help with the cramps. Maybe it’s that the vinegar leeches the nutrients from the cucumbers as they stew in the brine. That must add potassium and maybe magnesium to the juice?

(Scott) #10

What causes cramps? Aliens trying to exit your body! At least that what it feels like. I am doing much better now that I squirt a half dropper of Mega-Mag in my Hydro Flask each time I fill it. It is a larger size and I fill it when I go to bed and twice during the day. I have also increased my salt. In fact I just took my grinder of pink salt and ground some in my hand and popped it in my mouth to dissolve. I run 20 miles a week and do a Nautilus set three times a week and my calves are what cramp up if I don’t do this supplementation.

(It's all about the bacon, baby!) #11

This makes sense, since lack of salt throws off the balance of the other electrolytes. When salt is properly balanced, magnesium, potassium, and calcium stay properly balanced, as well. Dr. Phinney goes into the mechanism in several of his lectures, available on YouTube.

(Dirty Lazy Keto'er, Sucralose freak ;)) #12

Just had my Dr’s appointment yesterday, and lower leg cramps was the only negative thing I had to report. My Dr asked if I had been taking any potassium, and I told her I had. So aside from that she said it was possibly dehydration. I feel like I drink plenty… But maybe I’m slacking a little During my weekend driving marathon. My cramping has been worse / most consistent on Monday and Tuesday…


For what it’s worth, I’ve found that the old athlete’s/home remedy of drinking some pickle juice (or a shot of diluted apple cider vinegar) has actually worked when I’ve had severe, hop-out-of-bed-howling foot cramps at night. Don’t ask me about the actual mechanism of why it works (the theories do vary), but worth a shot.

(Mark Rhodes) #14


Helped me.

(Mark Rhodes) #15

(It's all about the bacon, baby!) #16

I imagine that being autopsied kind of ruins the rest of the day, no? :rofl::rofl:

(Mark Rhodes) #17

I think would alter the results, no?

(It's all about the bacon, baby!) #18

But we would know for sure! :grin:


A large drink of water usually clears them up for me. I take a diuretic for another health issue, and days I haven’t put enough water back in, lower leg cramps wake me and remind me. The biggest problem then is, I may as well stay up, because I will never get back to sleep.

(Bob M) #20

I wish I could figure it out. I had another cramp and the day before that got a blood test taken. All my values (potassium, magnesium, sodium) were normal. I’ve gone back to adding some potassium (via no salt) into my diet, although I take an ACE inhibitor, and the docs discourage taking potassium while taking an ACE inhibitor. I’ve also ordered another bottle of magnesium oil and have been putting this on my legs again (not necessarily to get the magnesium into the calves, but because that’s a large, easy-to-reach area).

Have these helped? It’s unclear. And, I’m concerned that if you increase, say, magnesium, then do you need more of the other elements, such as potassium, too? I’ve seen theories about this, but not a lot of actual data.

I’ll find out again next week, when I’m going to try for 4.5 days of fasting. I’m going to up my salt/mg/K content to see what happens.

As for taurine and the like, that’s interesting. Overall, I’m trying to avoid taking anything. I was down to vitamin D and magnesium oil. Then I tried a bunch of other protocols (iodine loading, liver) and they might have made things worse not better. So, I’m headed to try more whole foods, maybe even carnivore.